Adherence to treatment for tuberculosis infection in children using a comprehensive care strategy: a prospective cohort study with a historical control group

IF 7 Q1 HEALTH CARE SCIENCES & SERVICES

Lancet Regional Health-Americas Pub Date : 2025-04-22 DOI:10.1016/j.lana.2025.101094

Iader Rodríguez-Márquez , Dione Benjumea-Bedoya , Andrea Victoria Restrepo-Gouzy , Claudia Patricia Beltrán-Arroyave , Diana Marín , Fernando Nicolás Montes-Zuluaga , Juan Carlos Alzate-Ángel , Lina Marcela Cadavid-Álvarez , Lizeth Andrea Paniagua-Saldarriaga , Teresa Realpe , Yesenia Perea-Torres , Lisandra María Arango-García , Natalia Pérez-Doncel , María Patricia Arbeláez-Montoya , Jaime Robledo

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引用次数: 0

Abstract

Background

Low adherence to treatment for tuberculosis infection (TBI) in children threatens tuberculosis (TB) control goals. This research focuses on children with close contact to TB and TBI. This study evaluated adherence to treatment of TBI using a comprehensive care strategy (CCS) for close-contact children with pulmonary TB compared with standard of care (SOC).

Methods

A prospective cohort study with a historical control group was conducted on children under five, who were close contacts of patients with bacteriologically confirmed pulmonary TB in three Colombian cities (study registration number: NCT04331262). The CCS comprised clinical evaluations, rifampicin for four months, multidisciplinary care, and logistical support, while the SOC followed program regulations with isoniazid for nine months. The primary outcome was the proportion of children completing 100% treatment during follow-up, and the secondary outcome was treatment-related adverse events (AEs).

Findings

213 children in the SOC group and 86 children in the CCS group were analyzed. The treatment adherence in the SOC group was 40·8% (95% CI 34%; 48%), while in the CCS group it was 76·7% (95% CI 66%; 85%). Children exposed to CCS had 87% higher probability of adherence to TBI treatment compared to SOC (RR 1·87; 95% CI 1·52; 2·31). The incidence of AEs was lower in the CCS group (n = 3) than in those receiving SOC (n = 24).

Interpretation

The CCS increases adherence to treatment for TBI in children safely compared to SOC. Future cost-effectiveness studies will help implement this strategy in programmatic settings.

Funding

Colombian Ministry of Science, Technology and Innovation.

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采用综合护理策略对儿童结核感染治疗的依从性：一项具有历史对照组的前瞻性队列研究

背景：儿童结核病感染（TBI）治疗依从性低威胁到结核病（TB）控制目标。本研究的重点是与结核病和TBI密切接触的儿童。本研究评估了与标准治疗（SOC）相比，使用综合护理策略（CCS）对密切接触的肺结核儿童TBI治疗的依从性。方法对哥伦比亚3个城市与细菌学确诊肺结核患者密切接触的5岁以下儿童（研究登记号：NCT04331262）进行前瞻性队列研究，并建立历史对照组。CCS包括临床评估，4个月的利福平，多学科护理和后勤支持，而SOC遵循异烟肼的计划规定9个月。主要结局是随访期间儿童100%完成治疗的比例，次要结局是治疗相关不良事件（ae）。结果：SOC组213例，CCS组86例。SOC组治疗依从性为40.8% (95% CI 34%；48%)，而在CCS组为76.7% (95% CI 66%；85%)。暴露于CCS的儿童对TBI治疗的依从性比暴露于SOC的儿童高87% (RR为1.87；95% ci为1·52；2·31)。CCS组（n = 3）的ae发生率低于SOC组（n = 24）。与SOC相比，CCS增加了儿童TBI治疗的安全依从性。未来的成本效益研究将有助于在方案环境中执行这一战略。资助哥伦比亚科学、技术和创新部。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Lancet Regional Health-Americas Multiple-

CiteScore

8.00

自引率

0.00%

发文量

期刊介绍： The Lancet Regional Health – Americas, an open-access journal, contributes to The Lancet's global initiative by focusing on health-care quality and access in the Americas. It aims to advance clinical practice and health policy in the region, promoting better health outcomes. The journal publishes high-quality original research advocating change or shedding light on clinical practice and health policy. It welcomes submissions on various regional health topics, including infectious diseases, non-communicable diseases, child and adolescent health, maternal and reproductive health, emergency care, health policy, and health equity.